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16 August 2019 : Original article  

Analysis of Data from the Oxygen Persufflation in Liver Transplantation (OPAL) Study to Determine the Role of Factors Affecting the Hepatic Microcirculation and Early Allograft Dysfunction

Tamas Benkö1ABCDEFG*, Jennifer Belker1BF, Anja Gallinat1BD, Jürgen W. Treckmann1D, Andreas Paul1D, Thomas Minor1ADG, Dieter P. Hoyer1ABCDEFG

DOI: 10.12659/AOT.915214

Ann Transplant 2019; 24:481-488

Abstract

BACKGROUND: Adequate microcirculatory perfusion is essential for the provision of oxygen to the liver following transplantation. Data from the Oxygen Persufflation in Liver Transplantation (OPAL) study (ISRCTN00167887) were analyzed from liver transplants performed at a single center to determine the role of factors affecting the hepatic microcirculation and early allograft dysfunction (EAD).

MATERIAL AND METHODS: Retrospective data from 116 patients from the Oxygen Persufflation as Adjunction in Liver Transplantation (OPAL) study who underwent liver transplantation at a single center were analyzed. Oxygen saturation of hemoglobin (SO₂), relative capillary hemoglobin concentration (rHb), relative tissue blood flow (rBF) using laser Doppler flow measurements, and the Oxygen-to-See (O2C) spectrometry were measured and with post-transplant allograft function were analyzed using univariate and multivariate logistic regression statistics.

RESULTS: Livers donors had a median donor risk index of 1.8. Most liver transplant recipients were men (60.3%), with a median age of 54 years (IQR, 23–68 years). Mean post-transplant 3-month survival was 90.5%. The EAD rate was 22.4%, the median SO₂ was 78% (IQR, 29.5–95.8%), the median rHb was 55.6 AU (IQR, 16.8–74.8 AU), and the median rBF was 110.1 AU (IQR, 35.8–406.8 AU). Multivariate logistic regression analysis showed that tissue SO₂ (p=0.01), body mass index (BMI) of the transplant recipient (p=0.002), serum alanine transaminase (ALT) of the donor (p=0.02), and portal blood flow (p=0.01) were predictive factors for EAD.

CONCLUSIONS: Non-invasive investigations of the liver microcirculation and hemoglobin oxygenation were shown to be predictive factors for EAD following liver transplantation.

Keywords: perfusion imaging, Primary Graft Dysfunction, Risk Assessment, Hemodynamics, Liver, Liver Transplantation, Microcirculation, Risk Factors, transplant recipients, young adult

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358